Experts on Medicaid: Go slow

Three former administrators of the Centers for Medicare & Medicaid Services who served Republican presidents have a bit of advice for Democrats trying to get conservative governors to go ahead with Medicaid expansion: Be flexible. Don’t make it a political litmus test. And try not to pour fuel on what’s already a hot-burning fire.

The unexpected Medicaid ruling by the Supreme Court left the states with unexpected options and dozens of questions — and the three former CMS chiefs doubt they will be answered quickly, maybe not until after the elections.

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Some big name, big state Republican governors are in open revolt against the 2014 Medicaid expansion, and others are still trying to figure out the costs and benefits, both political and economic.

The three former administrators would counsel CMS to take it slow, avoid antagonizing states by issuing ultimatums and get ready for a whole new dynamic in the state-federal Medicaid negotiations — one in which the states have a lot more leverage than in the past.

“The big point is that states are going to get something as a result of the shift in the negotiating power with the federal government,” said Mark McClellan, who served under President George W. Bush and is now director of the Engelberg Center for Health Care Reform at the Brookings Institution. “That’s going to mean something, but we don’t know exactly what.”

With expansion now a political flash point, CMS flexibility could be the new name of the game.

“What you don’t want to do is make rejection of the Medicaid expansion a litmus test for Republicans,” said Tom Scully, who also served under President George W. Bush and is now a health care lobbyist. He recommended against telling states point blank that they can either take or leave the Medicaid expansion — and the billions in federal funding.

Readers' Comments (2)

Thomas Scully is a highly inappropriate cite for this article. This was a CMS Administrator who was forced to resign after being found to have committed numerous ethics violations, including embezelling nearly $10,000 for personal use and stock speculating in companies CMS regulated. Scully also created a culture of retaliation against any employee or outsider who complained about the incompetence or abuse of CMS rent-a-cops that GAO and OIG confirmed were ill-prepared for post 9-11 security demands. Both GAO and OIG found that Scully's lack of proper training and oversight jeopardized the safety of CMS employees and visitors.

Thomas Scully is a highly inappropriate cite for this article. This was a CMS Administrator who was forced to resign after being found to have committed numerous ethics violations, including embezelling nearly $10,000 for personal use and stock speculating in companies CMS regulated. Scully also created a culture of retaliation against any employee or outsider who complained about the incompetence or abuse of CMS rent-a-cops that GAO and OIG confirmed were ill-prepared for post 9-11 security demands. Both GAO and OIG found that Scully's lack of proper training and oversight jeopardized the safety of CMS employees and visitors.